Featured Interview: Expert Insight into Understanding & Managing Hearing Loss

Hearing loss is more common than one might think and even though age plays an important role in hearing loss, young people can also suffer from hearing loss and other ear disorders. It is estimated that 1 in 11 people in Singapore suffer from some degree of hearing loss.

We posed some questions on hearing loss and management of hearing conditions to Dr. Rebecca Heywood,  Senior Consultant in Otolaryngology-Head & Neck Surgery/ Otology, Neurotology & Hearing Implants at Nuffield Medical, Singapore.

Read on to find her insightful answers:

DR Rebecca Heywood

Q. What are the common types of hearing losses one should be aware of?

Dr. Heywood:  There are three main types of hearing loss. By far the most common is sensorineural hearing loss when the inner ear (cochlea), auditory (cochlear) nerve or central auditory pathways to the brain are damaged or malformed. Conductive hearing loss occurs when sound conduction through the outer or middle ear is impeded, meaning that sound can’t get to the cochlea in the way that it should. And finally mixed hearing loss is when there is a combination of both conductive and sensorineural hearing loss. Hearing loss may come on gradually or suddenly. Sudden sensorineural hearing loss is considered an emergency and should be treated urgently.

Q. Is some degree of hearing loss natural after a certain age?

Dr. Heywood: Yes, some degree of hearing loss is extremely common as we get older. This condition is often referred to as presbycusis. Presbycusis typically occurs gradually and affects both ears equally. It primarily involves a gradual decline in the ability to hear high-pitched sounds. Several factors contribute to age-related hearing loss, including changes in the inner ear,
changes in the middle ear, and changes in the nerves leading from the ear to the brain. Exposure to loud noises over the years, genetics, certain medical conditions, and certain medications can also play a role in age-related hearing loss. In other words, it is the sum of all the small insults to our ears over many years and the degeneration that occurs in all parts
of our body as we age. While age-related hearing loss is common, that doesn’t mean that we shouldn’t treat it!
Hearing loss affects older people detrimentally just as it does younger people. The degree and impact can vary from person to person. Regular hearing tests can help identify and address hearing loss early, and hearing rehabilitation may be recommended to improve communication and quality of life for individuals experiencing age-related hearing loss.

Q. Does hearing loss become progressively worse? Is there anything that one can do to
reverse the damage and/ or prevent further damage?

Dr. Heywood: It depends on the type of hearing loss and the cause. In some cases, hearing loss may be reversible or partially reversible with appropriate medical intervention. Earwax and outer and middle ear infections are causes of conductive hearing loss that can be treated easily and the hearing loss will resolve. However, it’s crucial to note that sensorineural hearing loss, which is the most common type of hearing loss, is generally not reversible. Once the hair cells in the inner ear are damaged,
they do not regenerate, and the hearing loss is considered permanent. This is particularly worrying in our young people, an increasing number of whom are affected by permanent, irreversible sensorineural hearing loss due to recreational exposure to loud sound! Some types of sensorineural hearing loss do not progress and stay the same over many
years. Other types, such as age-related hearing loss, tend to be progressive, meaning it gradually worsens over time. However, there are steps individuals can take to manage and potentially slow down the progression of hearing loss – see last question answers below.

Q.I need to strain my ears or turn up the volume to hear better. Is this a cause for concern? Do I need medical intervention?

Dr. Heywood: Yes, these symptoms can be indicative of hearing loss, and it’s important to have your hearing evaluated by a healthcare professional, such as an audiologist or an ear, nose, and throat (ENT) specialist. You may or may not need medical intervention depending on their findings. Hearing loss often comes on very insidiously. As a result, even the person with hearing loss may not know that they have got it. Furthermore, it does not just lead to a reduction in volume. Inner ear (sensorineural) hearing loss also causes a reduction in clarity because the inner ear can no longer accurately transmit all the information received by the ear to the brain. As a result, the first things that adults may notice is that they can hear people talking but can’t quite understand what they are saying. This problem is worse in when there is background noise, for example when several people are talking or in a restaurant.

Ignoring signs of hearing loss and not seeking timely intervention can have various consequences including:

  • Speech and language delay in children.
  • Communication Difficulties: Hearing loss can make it challenging to understand conversations, especially in noisy environments. This can lead to social isolation and difficulty in professional and personal relationships.
  • Impact on Mental Health: Untreated hearing loss has been linked to an increased risk of cognitive decline, dementia, depression and anxiety. Addressing hearing loss may contribute to better overall mental health. 

Q. Do hearing aids restore hearing to normal?

Dr. Heywood: Hearing aids are effective devices for managing hearing loss, but they typically do not restore hearing to “normal.” The extent of improvement provided by hearing aids depends on various factors, including the severity and type of hearing loss, as well as the user’s compliance with wearing them consistently. It’s also important to note that hearing aids
need to be selected carefully and fitted properly for your hearing loss by a trained professional. The earlier hearing loss is addressed with hearing aids, the better the outcomes generally are. Delaying the use of hearing aids may make it more challenging for the brain to adapt to amplified sounds. Hearing aids work by amplifying sounds, making them more audible for individuals with mild to severe hearing loss. Most inner ear hearing loss can be managed with a hearing aid. They are now smaller and more aesthetic than they used to be. In some cases, however, loss of speech clarity is so bad
that a hearing aid is no longer beneficial. This can be very distressing as no matter how much the sound is amplified, and how good the hearing aid, these people just can’t understand what people are saying. The good news is that they can benefit hugely from cochlear implants. I have seen people literally crying with joy when they are able to hear again! Cochlear implants consist of an external sound processor and a surgically implanted device with an electrode that is placed inside the cochlea itself. Sound is transmitted along the electrode straight to the cochlear (auditory) nerve to go to the brain, hence bypassing the cochlea. So however bad the hearing loss is, there are always treatment options available. Hearing aids and cochlear implants can also be used in conjunction with other technology in our busy lives. Music and phone calls can be directly streamed from smartphones to hearing aids and cochlear implants, for example.

Q. My child has ear infections frequently. Will that damage my child’s hearing?

Dr. Heywood: There are different types of ear infection and all can temporarily affect the hearing. Otitis externa is bacterial or fungal infection of the skin of an otherwise normal ear canal and commonly occurs after swimming. It causes ear discharge, blockage, itch and sometimes pain and hearing loss. Antibiotic drops or cream can be used to treat the infection.
Acute otitis media is a viral or bacterial infection behind the ear drum and usually occurs after a cold. Pus accumulates behind the eardrum and affects the normal transmission of sound, causing pain and hearing loss. In most cases, once the ear infection is treated and the fluid is cleared, the hearing loss resolves. Children who suffer from recurrent middle ear
infections may need to have grommets (ventilation tubes, small tubes inserted into the
eardrum) to prevent further fluid accumulation. Recurring ear discharge, especially if it is painless, may also indicate an underlying problem with the eardrum or middle ear which can affect the hearing and lead to more serious
consequences. Some of these conditions may lead to inner ear hearing loss if left untreated. Surgery may be recommended for conditions such as an eardrum perforation. If your child suffers from frequent ear infections then review by an ENT specialist is warranted.

Q. How can an Otologist help with hearing issues? What line of treatment can the patient expect?

Dr. Heywood: An otologist is an Ear, Nose and Throat (ENT) surgeon who specialises in the diagnosis and treatment of ear disorders, including those related to hearing and balance. They can help with hearing issues in the following ways:
⮚ Diagnosis: Comprehensive testing to identify the cause
⮚ Treatment of underlying conditions with medicine, such as ear infections
⮚ Surgery: Otologists perform surgery to address issues affecting hearing, for example reconstructing the eardrum and middle ear hearing bones
⮚ Hearing Aid Evaluation: Otologists can assess the degree and type of hearing loss and may recommend hearing aids as a treatment option.
⮚ Cochlear Implants and other hearing implants: An otologist can implant a device to restore the hearing when a patient cannot benefit from a hearing aid
⮚ Balance Disorders: Managing issues of the inner ear that affect both hearing and balance.

Q. How can one protect themselves from hearing damage? Are there any
recommended lifestyle or dietary changes that can affect auditory health?

⮚ Protect Your Ears: The main thing that damages our ears that we can do something about is noise!! Limit exposure to loud noises, both in terms of intensity and duration. This includes listening to music at an unsafe level through earbuds or headphones. Many smartphones now have software that can measure the noise level that you are listening to and advise on
how long you can safely listen at that volume. Use ear protection, such as earplugs or earmuffs when in loud environments, like concerts, construction sites, or other noisy settings. Noise cancelling ear buds or headphones can help to protect your ears when you are listening in a noisy background such as on public transport..
⮚ Regular Hearing Check-ups: Regular hearing assessments can help detect any changes in hearing early on. Early intervention may help in managing and adapting to hearing loss more effectively.
⮚ Manage Health Conditions: Some health conditions, such as diabetes and cardiovascular disease, have been associated with an increased risk of hearing loss. Managing these conditions through a healthy lifestyle and medical treatment may have a positive impact on hearing health.
⮚ Medication Awareness: Some medications, known as ototoxic drugs, can contribute to hearing loss. It’s important to be aware of the potential side effects of medications and discuss any concerns with a healthcare professional.

Dr. Rebecca Heywood is also our Expert Panelist, so just drop in your questions to her on hearing and ENT issues here